Provider Demographics
NPI:1376630897
Name:PHADKE, SATISH DOLLY (PT)
Entity Type:Individual
Prefix:MRS
First Name:SATISH
Middle Name:DOLLY
Last Name:PHADKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 E EVANS AVE
Mailing Address - Street 2:#115
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4096
Mailing Address - Country:US
Mailing Address - Phone:219-476-0377
Mailing Address - Fax:219-476-0388
Practice Address - Street 1:2102 E EVANS AVE
Practice Address - Street 2:#115
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4096
Practice Address - Country:US
Practice Address - Phone:219-476-0377
Practice Address - Fax:219-476-0388
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001870A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000093806OtherANTHEM
000000093806OtherANTHEM
S94987Medicare UPIN